The Tipping Point of Physician Burnout

The health care field is coming together to recognize the urgency of the problem, says a subject matter expert

One of the nation’s top authorities on physician burnout, Colin West, M.D., co-director of the Mayo Clinic's multidisciplinary Program on Physician Well-Being, has published more than 40 papers on physician burnout.

He and two Mayo Clinic colleagues summarized what they have learned in the Viewpoint section of the March 7 issue of The Journal of the American Medical Association.

What prompted you and your colleagues to write the Viewpoint piece?

West: Historically, there’s been a tendency to place the responsibility of solutions [for burnout] at the feet of individual physicians. Certainly, individual physicians need to have positive coping strategies and deal with stressful situations in a way that is appropriate. But that verges on a blame-the-victim mentality because we have come to understand that so much of the root of physician stress lies in our health care system and in our organizations.

One purpose of that paper was to briefly summarize a decade's worth of work from our group and others around the world, but then [that] led into: 'OK, what groups need to take responsibility for the solutions?' It was intended to help people who are responsible for higher-level leadership directions to recognize that this is a shared responsibility and they need to be stepping up to the plate.

One of the things that we are trying to emphasize is that addressing physician burnout is not a matter of 'Can we afford to do this?' Because [given] all the negative impacts of physician burnout, this is something we can't afford not to do.

Physician burnout has been discussed for many years now. What is the trigger prompting so many health system leaders to step to the forefront at this time?

West: Until as recently as maybe two years ago, I think the majority of organizations in medicine had sort of a rudimentary understanding of what the issues around physician burnout were. The cumulative effect of the literature has been such that it finally reached that tipping point where it became something that could not be ignored.

In 2015, we published a paper — we partnered with the AMA to identify the national rates of burnout and their change from 2011 to 2014 — that showed that, in those three years, the burnout rate across every specialty of medicine had worsened, on average, by 10 absolute percentage points. That was the first time, at least in national documentation, that the burnout rate was more than 50 percent. That served as a little bit of a focal point for the cumulative weight of evidence.

How will the National Academy of Medicine’s initiative to promote clinician well-being and combat burnout make a difference?

West: What we expect to come out of the NAM initiative is an elevation of that sense of responsibility from leaders in medicine around the country and around the world. They are saying: 'You know what? We do have a responsibility to improve the environments within which our physicians are practicing.'

This is not a selfish thing for physicians. This is actually in service of optimal patient care because we know that when physicians are gaining more meaning in their work, are more satisfied in their work and are less burned out, they are better able to meet the needs of our health care system and our patients.

Getting a large national group of leaders together to realize that they are not alone in this is hugely impactful in changing the direction nationally. Until now, if you are the leader of a health care organization, you may be wondering, 'How committed to this should I really be? I'm not sure that I'm ready to be the first adopter of major changes like this.'

But when you get a major group together as the National Academy of Medicine is doing, people start to realize, 'I'm not the first adopter. This is actually a wave, and I need to be part of this wave or I'm going to be left behind.'

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